Skin Cancer, Nonmelanoma

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Skin Cancer, Nonmelanoma

Topic Overview

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This topic is about nonmelanoma skin cancer, including basal cell cancer and squamous cell cancer. For information about melanoma skin cancer, see the topic Skin Cancer, Melanoma.

What is nonmelanoma skin cancer?

Skin cancer is the abnormal growth of cells in the skin. It is the most common type of cancer. It is almost always cured when it is found early and treated. So it is important to see your doctor if you have changes in your skin.

Most skin cancers are the nonmelanoma type. There are two main types of nonmelanoma skin cancer:

  • Basal cell carcinoma. Most nonmelanoma cancers are this type. It can damage deeper tissues, such as muscles and bones. It almost never spreads to other parts of the body.
  • Squamous cell carcinoma. This type is less common. It often starts in skin that has been injured or diseased. It sometimes spreads to other parts of the body.

There are other types of skin cancer that are not melanoma. But these are much less common. They include Merkel cell carcinoma and several kinds of sarcomas.

What causes it?

Nonmelanoma skin cancer is usually caused by too much sun. Using tanning beds or sunlamps too much can also cause it.

How is nonmelanoma skin cancer diagnosed?

Skin cancer usually appears as a growth that changes in color, shape, or size. This can be a sore that does not heal or a change in a wart or a mole. These changes usually happen in areas that get the most sun—your head, neck, back, chest, or shoulders. The most common place for skin cancer is your nose.

Your doctor will use a biopsy to find out if you have skin cancer. This means taking a sample of the growth and sending it to a lab to see if it contains cancer cells.

What increases my risk for nonmelanoma skin cancer?

If you have light skin that sunburns easily, you are more likely to get skin cancer.

Your risk is higher if you are male or if you are over 40. Your risk is higher if others in your family have had it or if you have had it before.

You may also be more likely to get it if you have been exposed often to strong X-rays, to certain chemicals (such as arsenic, coal tar, and creosote), or to radioactive substances (such as radium).

How is it treated?

Your doctor will want to remove all of the cancer. There are several ways to do this. The most common way is to numb your skin so that it does not hurt, then cut out the cancer. You will be awake while this is done.

This surgery almost always cures nonmelanoma skin cancer.

After your treatment, you will need regular checkups because having skin cancer once means you are more likely to get it again.

Can nonmelanoma skin cancer be prevented?

You can prevent it by being careful in the sun. Stay out of the sun at midday, when the sun’s rays are strongest. Wear sunscreen or other sun protection. Do not use tanning booths or sunlamps.

Frequently Asked Questions

Learning about skin cancer:

Being diagnosed:

Getting treatment:

Living with skin cancer:

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  Skin Cancer: Protecting Your Skin

Cause

Nonmelanoma skin cancer is usually caused by overexposure to the sun and its ultraviolet (UV) rays. Overexposure to UV rays can result from:

  • Having severe sunburn and blistering, especially during childhood.
  • Spending a lot of time in the sun over many years.
  • Using tanning beds or sunlamps, which are artificial sources of UV rays.

Other possible causes of skin cancer include repeated exposure to X-rays, certain chemicals (such as arsenic, coal tar, creosote), and radioactive substances (such as radium). Skin cancer may also be caused by ionizing radiation treatments for skin conditions such as psoriasis or acne.

Symptoms

Nonmelanoma skin cancer may appear as a change in the skin, such as a growth, an irritation or sore that does not heal, or a change in a wart or a mole.

Basal cell carcinoma usually affects the head, neck, back, chest, or shoulders. The nose is the most common site. Basal cell carcinoma occurs much more often than squamous cell carcinoma. There are several types of basal cell carcinoma, including nodular, superficial, and sclerosing (morpheaform). They look different but they all need the same treatment. Signs of basal cell carcinoma can vary depending on the type and may include skin changes such as a:

  • Firm, pearly bump with tiny blood vessels in a spiderlike appearance (telangiectasias).
  • Red, tender, flat spot that bleeds easily.
  • Small, fleshy bump with a smooth, pearly appearance, often with a depressed center.
  • Smooth, shiny bump that may look like a mole or cyst.
  • Patch of skin, especially on the face, that looks like a scar and is firm to the touch.
  • Bump that itches, bleeds, crusts over, and then repeats the cycle and has not healed in a few weeks.
  • Change in the size, shape, or color of a wart or a mole.

Squamous cell carcinoma usually affects the face, head, or neck. Signs of squamous cell carcinoma include any:

  • Persistent, firm, red bump on sun-exposed skin.
  • Patch of skin that feels scaly, bleeds, or develops a crust. The patch may get bigger over a period of months and form a sore.
  • Skin growth that looks like a wart.
  • Sore that does not heal or an area of thickened skin on the lower lip, especially if you smoke or use chewing tobacco or your lips are often exposed to the sun and wind.

Other conditions, such as actinic keratosis, may have symptoms similar to skin cancer. It is important to have any new or persistent skin change evaluated by your doctor.

What Happens

Nonmelanoma skin cancer usually develops slowly, invading and destroying nearby tissues. It may take months or years for basal cell or squamous cell carcinomas to develop. Because of this slow growth, skin cancer can often be detected and treated early in its development, increasing the chance for a cure.

Basal cell carcinoma

Basal cell carcinoma can invade normal skin tissue and damage deeper tissues, such as muscles and bones, and affect the appearance of the skin. Basal cell carcinoma very rarely spreads (metastasizes) to other parts of the body.

After you have one basal cell carcinoma, you are more likely to have another one develop in a new place. If basal cell carcinoma comes back at the same place (recurs), it may grow faster and cause more tissue damage.

Squamous cell carcinoma

Squamous cell carcinoma is more invasive than basal cell and can spread from the scalp, ears, eyelid, nose, or lip to other areas of the body. But it rarely spreads (metastasizes) to other parts of the body.

Sometimes a squamous cell carcinoma starts as actinic keratosis, which are small rough spots that grow in sun-damaged skin. Actinic keratosis is not a skin cancer, but it may lead to skin cancer.

What Increases Your Risk

Risk factors for nonmelanoma skin cancer include:

  • Sunlight, sun lamps, or tanning beds. These expose you to ultraviolet (UV) radiation.
    • UV radiation affects people of all skin types, but especially those with light skin color, freckles, blond or red hair, and blue or light-colored eyes.
    • Living where you get high levels of UV radiation. People living closer to the equator get more UV radiation. And people who live at higher altitudes, such as in the mountains, get more UV radiation.
  • A family history of skin cancer or a personal history of skin cancer. Or other things that affect your skin, such as:
    • Inherited genetic disorders, such as xeroderma pigmentosum.
    • A history of severe sunburns, especially during childhood.
    • Scars from severe burns or inflammatory skin conditions.
  • Being older than 40.
  • Being male. Men develop skin cancer more often than women.
  • Smoking.
  • Repeated exposure to X-rays, certain chemicals (such as arsenic, coal tar, creosote), and radioactive substances (such as radium).
  • Being infected with a certain type of human papillomavirus (HPV).

Basal cell and squamous cell carcinomas can occur in people with dark skin. But these cancers are much more common in people with light skin.

The risk of squamous cell carcinoma is higher in people who have weakened immune systems. This includes people who have had organ transplants and take medicines to prevent rejection of the new organ.

When To Call a Doctor

Call your doctor if you have an irritated or irregular skin growth. This includes any:

  • Firm, pearly bump with tiny blood vessels in a spiderlike appearance (telangiectasias).
  • Red, tender, flat spot that bleeds easily.
  • Small, fleshy bump with a smooth, pearly appearance, often with a depressed center.
  • Smooth, shiny bump that may look like a mole or cyst.
  • Patch of skin, especially on the face, that looks like a scar and is firm to the touch.
  • Bump that itches, bleeds, crusts over, and then repeats the cycle and has not healed in 3 weeks.
  • Change in a wart or a mole, including a change in size, shape, or color.
  • Area of normal skin that quickly changes shape or appearance.

Be sure to show your doctor any skin growths that concern you so that they can be evaluated and treated if necessary.

Watchful Waiting

Watchful waiting, or surveillance, is a period of time during which you and your doctor observe your symptoms or condition without using medical treatment. Watchful waiting is not appropriate if you suspect that you have nonmelanoma skin cancer. The earlier skin cancer is detected, the sooner it can be effectively treated.

Who To See

Health professionals who can examine and diagnose a suspicious skin growth include:

Doctors who can remove a large skin growth or one in a noticeable area while minimizing scars that may result from surgery include:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Nonmelanoma skin cancer is diagnosed by:

  • Your medical history. Your doctor will ask when the skin change occurred, whether you have been exposed to substances (such as arsenic) that can cause skin cancer, and whether you have any personal or family history of skin cancer.
  • A physical exam of the skin growth. Your doctor can often tell what a skin growth is by looking at it. He or she may decide to monitor changes in the skin growth or take a sample of the skin growth for further testing.
  • A skin biopsy. This is usually done when an area of skin has changed color, shape, size, or appearance or has not healed and skin cancer is suspected. A skin biopsy also may be done if the cause of a skin problem is not easily identified.

Early detection

Take steps to detect skin cancer early:

  • Examine your skin once a month, and ask your doctor to look at any suspicious skin growths.
  • Talk to your doctor about your own personal risk for skin cancer so that you understand the precautions that you need to take.
  • Have your doctor look for any suspicious skin growths during any health examination.

Treatment Overview

The goals of treatment for nonmelanoma skin cancer are to:

  • Remove the entire skin cancer and a margin of skin tissue around the cancer to reduce the chance of recurrence.
  • Preserve nearby skin tissue that is free of cancer and minimize scarring after surgery.

Initial treatment

Treatment for nonmelanoma skin cancer depends on the size and location of the cancer, whether it is basal cell or squamous cell, and your age and overall health. The type of treatment will also depend on whether you have had skin cancer at that place before and whether the cancer is in a place where you have had radiation therapy. Because skin cancer usually grows slowly, it often can be detected early and successfully treated.

The most common treatment is surgery to destroy or remove the entire skin growth, including a margin of cancer-free tissue around the growth. Most surgical treatments are very effective, with high cure rates.

The main treatment options are:

  • Mohs micrographic surgery. This surgery removes the skin cancer one layer at a time, checking each layer for cancer cells right after it is removed.
  • Excision. Excision removes the skin cancer along with some healthy skin tissue around it (margin).
  • Curettage and electrosurgery. Curettage uses a spoon-shaped instrument (curette) to scrape off the skin cancer, and electrosurgery controls the bleeding and destroys any remaining cancer cells.
  • Cryosurgery. Cryosurgery destroys the skin cancer by freezing it with liquid nitrogen.

Each of these treatments has advantages and disadvantages. Discuss your options with your doctor.

Other treatments that are used include radiation therapy, carbon dioxide laser, topical fluorouracil (5-FU), and photodynamic therapy.

Ongoing treatment

Follow-up treatment for nonmelanoma skin cancer includes skin self-exams and regular exams by your doctor. These exams are extremely important to reduce the risk of the cancer coming back (recurrence).

Almost half of people who have a nonmelanoma skin cancer will develop another one within 5 years.1 Your doctor may schedule you for exams as often as every 3 to 6 months for the first 2 years and yearly after that, especially for squamous cell carcinoma.

Treatment if the condition gets worse

Surgery is usually very effective for both basal and squamous cell carcinoma. But in rare cases, the cancer can spread to other parts of your body. This is more likely with squamous cell cancer than with basal cell.

If the cancer does spread, chemotherapy may be used. Your doctor may suggest that you enroll in a clinical trial if one is available.

What To Think About

Precancer skin growths, such as actinic keratoses and Bowen's disease, can develop into squamous cell skin cancer if they are not treated.

For more information about specific skin cancer treatment, see the following topics:

Prevention

Most nonmelanoma skin cancer can be prevented by protecting your skin from the sun and ultraviolet (UV) radiation.

  • Limit your exposure to the sun, especially from 10 a.m. to 4 p.m., the hours of peak ultraviolet exposure.
  • Wear protective clothing, including a wide-brimmed hat, a long-sleeved shirt, and pants.
  • Wear sunglasses that block UV rays.
  • Use a sunscreen that has a sun protection factor (SPF) of at least 15 every day, all year, even when it is cloudy. Sunscreens that say "broad-spectrum" can protect the skin from ultraviolet A and B (UVA and UVB) rays. Sunscreens come in lotions, gels, creams, and ointments.
  • Use lip balm or cream that has sun protection factor (SPF) to protect your lips from getting sunburned or developing cold sores.
  • Avoid tanning booths and sunlamps, which emit UV radiation and can cause skin damage.

Skin protection for children

Children and babies should be protected from the sun. You should start protecting your child from the sun when he or she is a baby. Because children and teens spend a lot of time outdoors playing, they get most of their lifetime sun exposure in their first 18 years.

  • Teach your children that it is important to protect their skin from the sun.
  • Have your children wear protective clothing, sunglasses, and a hat when they are in the sun.
  • Have your children wear sunscreen. Choose a sunscreen with SPF 15 or higher. Follow the instructions on the sunscreen. Reapply sunscreen after 2 hours in the sun or water, even if the sunscreen is waterproof.
  • Keep babies younger than 6 months out of direct sunlight.

Some people believe that a tan may protect them against a sunburn and skin damage. But the amount of sun exposure needed to get a tan can by itself cause skin damage.

For more information, see:

Click here to view an Actionset. Skin Cancer: Protecting Your Skin.

Home Treatment

Home treatment after removal of a skin cancer includes regular use of skin protection measures to prevent a return (recurrence) of nonmelanoma skin cancer and regular exams to watch for suspicious skin changes.

Perform a skin self-exam once a month.

  • Check your skin and skin growths for any changes in color, shape, size, or appearance.
  • Look for any diseased area of skin that has not healed.
  • Report any suspicious changes in your skin to your doctor.

Certain medicines, such as some antibiotics or diuretics, can make your skin more sensitive to the sun's rays. Ask your doctor about this potential side effect of your medicines, and take extra precautions if necessary.

Medications

Medicines are rarely used to treat nonmelanoma skin cancer. Surgery is the most common and the most effective treatment. But when surgery is not possible, your doctor may suggest medicines. Medicines may also be used when a skin cancer is too large for surgery or when new skin cancers keep appearing.

Medication Choices

Medicines that may be used to treat nonmelanoma skin cancer include:

  • Fluorouracil (5-FU). With topical chemotherapy, the medicine that kills cancer cells is in a cream or lotion that is put right on the skin. Treatment with 5-FU cream or lotion is used for both basal cell and squamous cell carcinomas that are superficial (only in the top layer of skin).
  • Imiquimod 5% cream (Aldara). Imiquimod is used to treat superficial basal cell cancer on the skin of the body, neck, arms, or legs, but it is not approved for treating the face.

People treated with medicines will need to have regular follow-up visits with their doctors to make sure the skin cancer is gone.

Chemotherapy may be used to destroy cancer cells in the small number of people who have basal cell or squamous cell carcinoma that has spread (metastasized) to other organs in the body, though metastasis is rare.

What To Think About

Medicines such as 5-FU and imiquimod may cause your skin to be sore. Your skin may turn red, swell, itch, or break out in a rash. Your skin may also be sensitive to sunlight. If your skin turns too red or raw, your doctor may stop the treatment.

How well medicines work for nonmelanoma skin cancer is not fully known. Studies are currently being done on the following medicines to find out their effectiveness.

  • Interferon is a substance produced by the body that helps the immune system fight disease more effectively.
  • Tretinoin (Retin-A) cream is derived from vitamin A and is one of a class of substances called retinoids. Tretinoin cream may prevent new skin cancers in people who have an increased risk for skin cancer.

Surgery

Surgery is the most common and most successful method of treating nonmelanoma skin cancer. The goals of surgery are to:

  • Remove the entire skin cancer and a margin of healthy skin tissue around the cancer to reduce the chance of recurrence.
  • Preserve nearby skin tissue that is free of cancer and minimize scarring after surgery.

Surgery Choices

The main types of surgery for nonmelanoma skin cancer include:

  • Mohs micrographic surgery. This surgery removes the skin cancer one layer at a time, checking each layer for cancer cells right after it is removed.
  • Excision. Excision removes the skin cancer along with some healthy skin tissue around it (margin).
  • Curettage and electrosurgery. Curettage uses a spoon-shaped instrument (curette) to scrape off the skin cancer, and electrosurgery controls the bleeding and destroys any remaining cancer cells.

Each type of treatment has advantages and disadvantages. Discuss your options with your doctor.

What To Think About

If squamous cell carcinoma has spread to the lymph nodes, surgery to remove the affected lymph nodes (lymphadenectomy) may be done. Radiation or chemotherapy may be recommended after surgery.

Other Treatment

Radiation therapy for nonmelanoma skin cancer may be recommended for people who may not be able to have surgery because of the location of the skin cancer. Radiation therapy may also be a treatment choice if age or other health conditions make surgery too risky. Radiation therapy is most often used for older adults. It may lead to other skin cancers in younger people as they age.

Other treatments for people who cannot have surgery or radiation include:

These three treatments may also work well for people who have low-risk shallow cancers, such as squamous cell carcinoma in situ (Bowen's disease) or low-risk superficial basal cell carcinoma.1

Lasers, such as the carbon dioxide laser, may be used to treat superficial basal cell carcinomas and actinic keratoses. Lasers use an intense beam of light as a scalpel to remove skin cancer.

Other Places To Get Help

Organizations

American Academy of Dermatology
P.O. Box 4014
Schaumburg, IL  60168
Phone: 1-866-503-SKIN (1-866-503-7546) toll-free
(847) 240-1280
Fax: (847) 240-1859
Web Address: www.aad.org
 

The American Academy of Dermatology provides information about the care of skin, hair, and nails. You can find a dermatologist in your area by calling 1-888-462-DERM (1-888-462-3376).


American Cancer Society (ACS)
Phone: 1-800-ACS-2345 (1-800-227-2345)
TDD: 1-866-228-4327 toll-free
Web Address: www.cancer.org
 

The American Cancer Society (ACS) conducts educational programs and offers many services to people with cancer and to their families. Staff at the toll-free numbers have information about services and activities in local areas and can provide referrals to local ACS divisions.


National Cancer Institute (NCI)
6116 Executive Boulevard
Suite 300
Bethesda, MD  20892-8322
Phone: 1-800-4-CANCER (1-800-422-6237)
Web Address: www.cancer.gov (or https://cissecure.nci.nih.gov/livehelp/welcome.asp# for live help online)
 

The National Cancer Institute (NCI) is a U.S. government agency that provides up-to-date information about the prevention, detection, and treatment of cancer. NCI also offers supportive care to people who have cancer and to their families. NCI information is also available to doctors, nurses, and other health professionals. NCI provides the latest information about clinical trials. The Cancer Information Service, a service of NCI, has trained staff members available to answer questions and send free publications. Spanish-speaking staff members are also available.


Related Information

References

Citations

  1. National Comprehensive Cancer Network (2010). Basal cell and squamous cell skin cancers. NCCN Clinical Practice Guidelines in Oncology, Version 1. Available online: http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf.

Other Works Consulted

  • Hall JC (2010). Tumors of the skin. In JC Hall, BJ Hall, eds., Sauer’s Manual of Skin Diseases, 10th ed., pp. 280–304. Philadelphia: Lippincott Williams and Wilkins.
  • Halpern AC, Myskowski PL (2009). Malignant cutaneous tumors. In EG Nabel, ed., ACP Medicine, section 2, chap. 10. Hamilton, ON: BC Decker.
  • Marks VJ, Hanson NW (2010). Non-melanoma skin cancer. In JC Hall, BJ Hall, eds., Sauer’s Manual of Skin Diseases, 10th ed., pp. 305–311. Philadelphia: Lippincott Williams and Wilkins.
  • National Cancer Institute (2010). Skin Cancer PDQ: Treatment – Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/skin/HealthProfessional.
  • National Cancer Institute (2010). Skin Cancer PDQ: Treatment – Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/skin/patient.
  • Ormerod A, et al. (2010). Basal cell carcinoma, search date December 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
  • Spencer JM (2010). Basal cell carcinoma. In MG Lebwohl et al., eds., Treatment of Skin Disease: Comprehensive Therapeutic Strategies, 3rd ed., pp. 78–82. Edinburgh: Saunders Elsevier.
  • Waldorf HA (2010). Squamous cell carcinoma. In MG Lebwohl et al., eds., Treatment of Skin Disease: Comprehensive Therapeutic Strategies, 3rd ed., pp. 702–706. Edinburgh: Saunders Elsevier.
  • Wolff K, Johnson RA (2009). Precancerous lesions and cutaneous carcinomas. In Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, 6th ed., pp. 274–299. New York: McGraw-Hill Medical.

Credits

By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Randall D. Burr, MD - Dermatology
Last Revised October 1, 2010

Last Revised: October 1, 2010

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